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Study suggests inequities in cardiovascular care are putting older females’ heart health at risk

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Inequities in cardiovascular care may put older women with atrial fibrillation at higher risk of stroke. Credit: ICES

Higher stroke risk among females with atrial fibrillation may be related to sex-based disparities in cardiovascular care, according to a new study from Women’s College Hospital, the Peter Munk Cardiac Center (PMCC) at University Health Network (UHN) and ICES.

Atrial fibrillation (AF) is a common type of irregular heart rhythm that is associated with a higher risk of stroke—after the age of 40, one in four strokes are caused by AF. Previous studies have found that female sex (assigned at birth) is a risk factor for AF-associated stroke. Recent research suggested that are only at higher risk than males with AF if they have another factor predisposing them to stroke (such as , hypertension, or diabetes).

The reasons for this higher stroke risk in females has not been well-examined. The authors hypothesized this was because these were less well-treated in older females, rather than female sex intrinsically predisposing to this higher risk.

The population-based cohort study, published in the European Heart Journal, analyzed health records for people aged 65 and older recently diagnosed with AF in Ontario, Canada. The cohort included 354,254 people (49% female), with an average age of 78 years. The study was made possible through the Early Career Women’s Heart and Brain Health Chair and a National New Investigator Award from the Heart and Stroke Foundation of Canada.

“After taking into account the age of the individual and differences in cardiovascular care, the data show that stroke risk was similar between males and females under the age of eighty, but that female sex was an over the age of eighty,” says lead author Hifza Buhari, family medicine resident at the University of Toronto and former Temerty medical student at Women’s College Hospital. “Females tend to be diagnosed with at older ages, and they may not be receiving adequate monitoring or treatment to reduce their stroke risk.”

The data also show that, compared to males:

  • Females were diagnosed more often in emergency departments (30% versus 25% for males)
  • Females received fewer cardiologist appointments, both in the year before (12% versus 17%) and after (31% versus 37%) AF diagnosis.
  • Females were also less likely to get LDL-C testing and be treated with statins, despite having higher LDL-C levels and higher BP than their male counterparts.

“Equalizing cardiovascular care for males and females is an important step towards healthier hearts and lives for everyone,” says senior author Husam Abdel-Qadir, cardiologist at Women’s College Hospital and Peter Munk Cardiac Center, University Health Network, and scientist with Women’s College Research Institute, Ted Rogers Center for Heart Research, and ICES. “By addressing sex inequities, we can increase the likelihood that every individual receives the best chance at a heart-healthy future.”

One limitation of the data is that the researchers could not account for variables such as race, AF type or severity, and other clinical factors, which may had led to an underestimation of inequities in cardiovascular care that disproportionately affect older females.

“This study is another reminder that and stroke are not male diseases. Despite there being widespread appreciation that females with AF are at higher risk than males, they are getting less with real consequences. These data emphasize that females, particularly those at older ages, require appropriate care to reduce their risk of these serious diseases,” says Dr. Abdel-Qadir.

More information:
Husam Abdel-Qadir et al, Stroke risk in women with atrial fibrillation, European Heart Journal (2023). DOI: 10.1093/eurheartj/ehad508

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Whooping cough is at a decade-high level in US

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MILWAUKEE (AP) — Whooping cough is at its highest level in a decade for this time of year, U.S. health officials reported Thursday.

There have been 18,506 cases of whooping cough reported so far, the Centers for Disease Control and Prevention said. That’s the most at this point in the year since 2014, when cases topped 21,800.

The increase is not unexpected — whooping cough peaks every three to five years, health experts said. And the numbers indicate a return to levels before the coronavirus pandemic, when whooping cough and other contagious illnesses plummeted.

Still, the tally has some state health officials concerned, including those in Wisconsin, where there have been about 1,000 cases so far this year, compared to a total of 51 last year.

Nationwide, CDC has reported that kindergarten vaccination rates dipped last year and vaccine exemptions are at an all-time high. Thursday, it released state figures, showing that about 86% of kindergartners in Wisconsin got the whooping cough vaccine, compared to more than 92% nationally.

Whooping cough, also called pertussis, usually starts out like a cold, with a runny nose and other common symptoms, before turning into a prolonged cough. It is treated with antibiotics. Whooping cough used to be very common until a vaccine was introduced in the 1950s, which is now part of routine childhood vaccinations. It is in a shot along with tetanus and diphtheria vaccines. The combo shot is recommended for adults every 10 years.

“They used to call it the 100-day cough because it literally lasts for 100 days,” said Joyce Knestrick, a family nurse practitioner in Wheeling, West Virginia.

Whooping cough is usually seen mostly in infants and young children, who can develop serious complications. That’s why the vaccine is recommended during pregnancy, to pass along protection to the newborn, and for those who spend a lot of time with infants.

But public health workers say outbreaks this year are hitting older kids and teens. In Pennsylvania, most outbreaks have been in middle school, high school and college settings, an official said. Nearly all the cases in Douglas County, Nebraska, are schoolkids and teens, said Justin Frederick, deputy director of the health department.

That includes his own teenage daughter.

“It’s a horrible disease. She still wakes up — after being treated with her antibiotics — in a panic because she’s coughing so much she can’t breathe,” he said.

It’s important to get tested and treated with antibiotics early, said Dr. Kris Bryant, who specializes in pediatric infectious diseases at Norton Children’s in Louisville, Kentucky. People exposed to the bacteria can also take antibiotics to stop the spread.

“Pertussis is worth preventing,” Bryant said. “The good news is that we have safe and effective vaccines.”

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AP data journalist Kasturi Pananjady contributed to this report.

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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

The Canadian Press. All rights reserved.

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Scientists show how sperm and egg come together like a key in a lock

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How a sperm and egg fuse together has long been a mystery.

New research by scientists in Austria provides tantalizing clues, showing fertilization works like a lock and key across the animal kingdom, from fish to people.

“We discovered this mechanism that’s really fundamental across all vertebrates as far as we can tell,” said co-author Andrea Pauli at the Research Institute of Molecular Pathology in Vienna.

The team found that three proteins on the sperm join to form a sort of key that unlocks the egg, allowing the sperm to attach. Their findings, drawn from studies in zebrafish, mice, and human cells, show how this process has persisted over millions of years of evolution. Results were published Thursday in the journal Cell.

Scientists had previously known about two proteins, one on the surface of the sperm and another on the egg’s membrane. Working with international collaborators, Pauli’s lab used Google DeepMind’s artificial intelligence tool AlphaFold — whose developers were awarded a Nobel Prize earlier this month — to help them identify a new protein that allows the first molecular connection between sperm and egg. They also demonstrated how it functions in living things.

It wasn’t previously known how the proteins “worked together as a team in order to allow sperm and egg to recognize each other,” Pauli said.

Scientists still don’t know how the sperm actually gets inside the egg after it attaches and hope to delve into that next.

Eventually, Pauli said, such work could help other scientists understand infertility better or develop new birth control methods.

The work provides targets for the development of male contraceptives in particular, said David Greenstein, a genetics and cell biology expert at the University of Minnesota who was not involved in the study.

The latest study “also underscores the importance of this year’s Nobel Prize in chemistry,” he said in an email.

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Older patients, non-English speakers more likely to be harmed in hospital: report

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Patients who are older, don’t speak English, and don’t have a high school education are more likely to experience harm during a hospital stay in Canada, according to new research.

The Canadian Institute for Health Information measured preventableharmful events from 2023 to 2024, such as bed sores and medication errors,experienced by patients who received acute care in hospital.

The research published Thursday shows patients who don’t speak English or French are 30 per cent more likely to experience harm. Patients without a high school education are 20 per cent more likely to endure harm compared to those with higher education levels.

The report also found that patients 85 and older are five times more likely to experience harm during a hospital stay compared to those under 20.

“The goal of this report is to get folks thinking about equity as being a key dimension of the patient safety effort within a hospital,” says Dana Riley, an author of the report and a program lead on CIHI’s population health team.

When a health-care provider and a patient don’t speak the same language, that can result in the administration of a wrong test or procedure, research shows. Similarly, Riley says a lower level of education is associated with a lower level of health literacy, which can result in increased vulnerability to communication errors.

“It’s fairly costly to the patient and it’s costly to the system,” says Riley, noting the average hospital stay for a patient who experiences harm is four times more expensive than the cost of a hospital stay without a harmful event – $42,558 compared to $9,072.

“I think there are a variety of different reasons why we might start to think about patient safety, think about equity, as key interconnected dimensions of health-care quality,” says Riley.

The analysis doesn’t include data on racialized patients because Riley says pan-Canadian data was not available for their research. Data from Quebec and some mental health patients was also excluded due to differences in data collection.

Efforts to reduce patient injuries at one Ontario hospital network appears to have resulted in less harm. Patient falls at Mackenzie Health causing injury are down 40 per cent, pressure injuries have decreased 51 per cent, and central line-associated bloodstream infections, such as IV therapy, have been reduced 34 per cent.

The hospital created a “zero harm” plan in 2019 to reduce errors after a hospital survey revealed low safety scores. They integrated principles used in aviation and nuclear industries, which prioritize safety in complex high-risk environments.

“The premise is first driven by a cultural shift where people feel comfortable actually calling out these events,” says Mackenzie Health President and Chief Executive Officer Altaf Stationwala.

They introduced harm reduction training and daily meetings to discuss risks in the hospital. Mackenzie partnered with virtual interpreters that speak 240 languages and understand medical jargon. Geriatric care nurses serve the nearly 70 per cent of patients over the age of 75, and staff are encouraged to communicate as frequently as possible, and in plain language, says Stationwala.

“What we do in health care is we take control away from patients and families, and what we know is we need to empower patients and families and that ultimately results in better health care.”

This report by The Canadian Press was first published Oct. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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